Basic Information
| Provider Information | |||||||||
| NPI: | 1346284569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | EMILY | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET MALL | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732250 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET MALL | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 0390177-21 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | R 069318-7 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 024999800 | 05 | MN | MEDICAID | 0500004 | 01 | MN | MEDICA PRIMARY | OTHER | 132326C029 | 01 | MN | UCARE | OTHER | HP47350 | 01 | MN | HEALTHPARTNERS | OTHER | 0408143 | 01 | MN | MEDICA | OTHER | 1042079 | 01 | MN | PREFERRED ONE | OTHER | 41198800 | 05 | WI | MEDICAID | 84G19AN | 01 | MN | BCBS OF MN | OTHER | 962871042079 | 01 | MN | PREF ONE COM HLTH PLAN | OTHER | 2235959 | 01 | MN | AMERICA'S PPO | OTHER | 4304315 | 05 | MT | MEDICAID |